To Protect & Prevent:
Rebuilding California's Public Health System
  (Report #170, April 2003)

[To Protect and Prevent: Rebuilding California's Public Health System]


Endorsements and Quotes from Readers

"I strongly endorse your appeal for a strong public health system in the report, To Protect & Prevent: Rebuilding California’s Public Health System.  Particularly important, it seems to me, are your proposals for a State Board of Public Health (which I believe should also have authority to adopt public health regulations); for coordinating public health activities in government; and strengthening relationships between the State and local health departments.  I hope that these and other recommendations in the report can be implemented."

Lester Breslow, M.D., M.P.H.; Member, Los Angeles County Public Health Commission; Professor Emeritus and Former Dean, UCLA School of Public Health; Former Director of Public Health, State of California


"Recognition by the Commission of the critical role played by public health laboratories in protecting the public’s safety and their recommendation that this vital capacity be enhanced will provide powerful impetus to correct the present, dangerous, situation.  I commend the Commission for taking the stance that the public health system as now structured is not providing adequate protection to the people of California and that reorganization is mandated to ensure the necessary effectiveness and efficiency."

Sydney Harvey, Ph.D., Director, Los Angeles County Public Health Laboratory;
President, California Association of Public Laboratory Directors
"I commend the Commission for putting together this powerful report calling for reorganization of the California public health system.  As a physician who has worked for more than 20 years in local, state, national and international public health, and who has responsibility for the health and safety of thousands of employees in the US and abroad, I fully support these recommendations.  If implemented, I truly believe that lives can be saved and that the public and private sectors will have greater confidence in the efforts of our hard working public health professionals and organizations."
T. Warner Hudson, M.D., FACOEM, FAAFP
Director, Health, Safety and Environment, DST Output; Member, Disaster Subcommittee of American College of Occupational & Environmental Medicine


"This report is a "Code Blue" for the California Public Health system, but for much more.  Thanks to dedicated staff and magnificent history, California still has arguably the strongest health department in the country, despite the neglect and subordination it has suffered.  Sadly, nearly every other large health department in the nation is suffering from similar problems of diffusion of energy and lack of support.  Yet, Public Health in this nation could be resuscitated with genuine political support and leadership, and the structural repairs the report identifies.  The Commission's report should be required reading at every school of public health and of government in the nation."

Richard J. Jackson, M.D., M.P.H.
Director, National Center for Environmental Health
U.S. Centers for Disease Control and Prevention


"If these recommendations for active surveillance cultures of patients and implementation of contact isolation were implemented today in all California healthcare facilities, many, many lives would be saved and healthcare costs would be reduced.  We would be turning the tide on antimicrobial-resistant pathogens."

William R. Jarvis, M.D.
Director, Office of Extramural Research, National Center for Infectious Diseases
U.S. Centers for Disease Control and Prevention


“It was a pleasure to review the Little Hoover Commission's Report, To Protect and Prevent: Rebuilding California's Public Health System.  I strongly favor the reestablishment of the State Board of Health as the first step in the establishment of the process of rebuilding public health in California.  Next should come the establishment of public health as a separate organization within the Agency for Health and Human Services, the details to be worked out by the Board of Health, which must have an adequate staff to develop the details.  The task is an urgent one, particularly in view of the current health problems in California, including the potential threats posed by terrorism, particularly in our major ports.

I strongly favor the broad view of public health that is incorporated in the concept of population health.  We must develop policies based on the advances in knowledge of the determinants of health, the gradient in socioeconomic status and health, health disparities, and the importance of a broad-based collaborative approach on population health at the community level.  The broad based approach must be the foundation of the revitalized department.”

Philip R. Lee, M.D.
Former Assistant Secretary for Health, U.S. Health and Human Services
Consulting Professor, Stanford University


"The Little Hoover Commission’s historic report, To Protect and Prevent: Rebuilding California’s Public Health System, inspires a much needed renaissance of public health.  California enjoys enlightened and dedicated leadership in our Department of Health Services, where public health programs are currently situated.  But the lion’s share of DHS funding and human resources are necessarily focused on administering Medi-Cal and health care services for low income, high risk, and uninsured populations.  Recognizing this, the LHC report challenges the state to focus with equal resolve on strengthening and reorganizing the core functions of public health and prevention through a dedicated public health agency, led by a California Surgeon General, advised by a State Board of Public Health, and empowered to coordinate multidisciplinary education, prevention, and response capabilities at the state and local levels.  The LHC recommendations for reinvigorating public health will position California to lead the nation in effectively reducing preventable infectious, environmental, and lifestyle-related morbidity and mortality.  Let us implement this bold vision!"

Jack C. Lewin, M.D.
CEO, California Medical Association


"Thank you all for remarking on the border needs!  Speaking for myself (although a member of the US-Mexico Border Health Commission) I am appalled at the nonchalance and neglect of border needs that, if fixed, would solve everyday public health problems as well as have a surge capacity against a terrorism event."

Rosemarie Marshall Johnson, M.D.
Member, US-Mexico Border Health Commission


“I commend the Little Hoover Commission for prioritizing public health and clearly assessing its importance to the daily lives of Californians.  The report elevates the essential role of good science, sound expertise and professionalism in public health practice.  The emphasis on public health's public safety mission is crucial at this time in our history.  This report is to California what the Institute of Medicine report, The Future of the Public's Health, is to the nation.”

Poki Stewart Namkung, M.D., M.P.H.
President, California Conference of Local Health Officers
Health Officer/Director of Public Health, Berkeley City Health Department


“The Little Hoover Commission's report, To Protect and Prevent:  Rebuilding California's Public Health System, is a clarion call for a strong public health system in the nation's most populous state, and one that could serve as a model for the nation. By elevating public health to its rightful status -- not to be subsumed by individual health care or confused as merely public health for the poor -- as a critical societal function needed to protect each and every one of us. The bold recommendations deserve serious consideration, particularly in this critical juncture in our history where the light is deservedly shining on public health.”

Linda Rosenstock, M.D., M.P.H.
Dean, UCLA School of Public Health


"A masterful job with a complicated topic..."

George Rutherford, M.D.
Professor and Head of Division of Preventive Medicine
UCSF Medical School
Former State Health Officer, 1993-1995


“Thank you very much for the report from the Little Hoover Commission, To Protect and Prevent:  Rebuilding California’s Public Health System.  I read the report several times and I think it really hit the nail right on the head.  I’m totally in agreement with some of the solutions suggested.  Congratulations to you and the Commission for taking on this difficult task and delivering a straight forward, honest, but brutal, message.”

Joseph Silva, Jr., M.D.
Dean, School of Medicine
University of California, Davis


"The Little Hoover Commission report on California's public health system is right on target.  It brings the public protection mission of public health into clear focus, and exposes serious flaws in the bureaucracy that detract from that vital mission. Offering common sense system fixes, the report provides a clear blueprint for the resurgence of a public health system in California that is both cost effective and capable."

Kenneth Takata, Public Health Lab Director
Sacramento County Department of Health and Human Services